my first it's a women... no its a man

[emtcutie]

so I was doing a field shift for my class yesterday. Started off the same with chest pains and breathing difficulties. my shift ended at 7 and it was 6:30 when we got a call to assist another medic at a motor vehicle accident on the interstate. When we arrived on scene the other medic was cutting an older gentlman out of the car (which had flipped.) The 2 passengers were standing agaist the barrier, pretty much unscathed. We were instructed to take vitals and transport if patient didn't refuse. So, we took the 2 ladies (around my age actually) into the medic and i assign a emt-b to get vitals on the younger one, while i got them on the older girl. The paramedic was assting with extracation of the grampa. Appparently Grampa had been driving and got dizzy and passed out and flipped the car. I figured just another normal traffic accident. All the vitals check out and both patients only have mild abrasions on the arms. They wanted to be transported though because they wanted to be with their grandfather the hospital. We were just about to leave when a cop walks up with a silver purse and asks "whose purse is this" the older girl said it was hers. Then the cop kinda smiled and said "oh really' because there is weed in this" the girl immediatly starts denying its not her weed (even though it was found in a closed wallet). Then the cop asks "who was driving" and they both respond 'my grandfather" again the cop smirks and goes "really because your grandfather said you were driving (to the younger girl) and we found him in the passengar seat." The younger girl was like " my grandpa and i switched plces during the rollover." I am sitting here thinking this story is unbelivable. Anyways on the way to the hospital we were making small talk about fashion and whats "in style". We tot the triage nurse and i went to go do my paperwork. As I am about to leave the cop walks up and says "I need to speek with the young man and the young women in the car" 'I'm like sir it was 2 young women, the only man was the grandfather, and he can't be seen right now because they are trying to stabilize him. cop says" no no there was a man his name was (fake name) tyler. I was like HER name was (again fake name) taylor. And he shows me the i.d and indeed she was a he. I was like omgah, i didnt even notice. Anyways i show the cop where they are in triage and i get them to sign the hippa form, as they are signing i am watching more closely and i see a wig on, and what looks like a sock coming out of the bra. then when he spoke i was like omgah how did i not catch in on this. Anyways thats my story... it turned out to be a rather intresting day.

Edited April 5, 2011 by emtcutie

[HERBIE1]

Gotta love the job, eh?

In the demographic portion of our run report(electronic, of course) we have choices of male, female, and unknown. It's not too often we need to check that box, but it does happen- especially if the person has a gender neutral name such as Chris or Pat. Most of the time their gender is irrelevant to patient care, but sometimes it can make for an awkward moment.

We have a well know area of our city where a significant portion of the population is gay. I've dealt with transgendered, transvestites, women who are more masculine than I am, guys dressed as women who swear they were doing this as a "dare", and every other conceivable story. Quite entertaining, actually. LOL

[island emt]

Seeing how they were involved in a rollover MVC : did you or your partners not do a trauma assessment? This is something that might have been done as part of the total patient exam in documenting injuries OR the lack of them.

ALL pt's worthy of transporting from MVC's should at a minimum get a once over with you palpating all parts of the body to see if you elicit a pain response or notice deformities, contusions or wounds. People involved in MVC's tend to go into an adrenaline based shock and don't immediately notice many injuries, until said adrenaline wears off. Then all of a sudden when the nurse asks you why you didn't notice something such as this case you would of had a response.

[HERBIE1]

Seeing how they were involved in a rollover MVC : did you or your partners not do a trauma assessment? This is something that might have been done as part of the total patient exam in documenting injuries OR the lack of them.

ALL pt's worthy of transporting from MVC's should at a minimum get a once over with you palpating all parts of the body to see if you elicit a pain response or notice deformities, contusions or wounds. People involved in MVC's tend to go into an adrenaline based shock and don't immediately notice many injuries, until said adrenaline wears off. Then all of a sudden when the nurse asks you why you didn't notice something such as this case you would of had a response.

In a significant MVC, I agree with you, but...

Sounds great on paper, but in a minor MVC with a dented bumper and someone is C/O neck pain, are you going to be grabbing at their crotch to make sure you do a "thorough" assessment? Good luck with that. I don't know about you, but I do not strip someone nekid because they have an isolated hand injury.

[island emt]

In a significant MVC, I agree with you, but...

Sounds great on paper, but in a minor MVC with a dented bumper and someone is C/O neck pain, are you going to be grabbing at their crotch to make sure you do a "thorough" assessment? Good luck with that. I don't know about you, but I do not strip someone nekid because they have an isolated hand injury.

But in this case it was not a minor fender bender: It was a rollover with extrication required.

I would rather do a complete head to toe assessment and come up with negative findings , instead of some nurse at the hospital ER saying to me how come you didn't find that they had {::::::::] injury that would of been very obvious if a full assessment had been done.

It only takes about 30-45 seconds to accomplish a quick top to bottom, head to feet touch assessment to make sure that all is right or wrong.

Anecdotally : I saw a pt brought in to the trauma room where the pt was in full spinal immobilization following a crash. Unfortunately the crew didn't notice the impaled piece of the floor shift lever in the patients back because they didn't do their assessment properly. It wasn't found until the spinal X-rays came back. Quite the ass chewing came from the Docs and nursing staff over that. It was imbedded in the pt's liver. No wonder he was complaining about back pain. OOOOPPPPPPS!

Now in their defense , the pt was unbelted and had kissed the windshield so there were facial lacs and quite a bit of blood present , BUT they focused on the obvious and forgot to do the job properly.

And yes if someone needs to be transported from a MVC, I always do a quick touchy feeley to make sure. Found a few weapons that way on people you'd least expect it from.

[Del_Lacuy]

Anecdotally : I saw a pt brought in to the trauma room where the pt was in full spinal immobilization following a crash. Unfortunately the crew didn't notice the impaled piece of the floor shift lever in the patients back because they didn't do their assessment properly. It wasn't found until the spinal X-rays came back. Quite the ass chewing came from the Docs and nursing staff over that. It was imbedded in the pt's liver. No wonder he was complaining about back pain. OOOOPPPPPPS!

Now in their defense , the pt was unbelted and had kissed the windshield so there were facial lacs and quite a bit of blood present , BUT they focused on the obvious and forgot to do the job properly.

Wow. Sure would hate to have been on the receiving end of THAT ass-chewing. I'll be sure to remember to focus on the obvious trauma AND remember to perform a full assessment; learning from said crew's mistakes. Being a student, info like this helps a lot. Thanks, island!

@ OP: I currently work at a call center and have had a few occasions of mistaking a caller's gender, although its different because all I hear is their voice. Now we're trained to address all our clients by their first-names, however, so we won't offend by mistake.

[Richard B the EMT]

Now in their defense , the pt was unbelted and had kissed the windshield so there were facial lacs and quite a bit of blood present , BUT they focused on the obvious and forgot to do the job properly.

1) That is why it is called, by my training, anyway, a "Distracting Injury". They seem to cause tunnel vision in EMS crews, distracting them from other, and potentially worse, injuries.

@ OP: I currently work at a call center and have had a few occasions of mistaking a caller's gender, although its different because all I hear is their voice. Now we're trained to address all our clients by their first-names, however, so we won't offend by mistake.

2) OR...call the caller by the catch all name of "Caller", as I was taught to do, when I worked in EMD.

[emtcutie]

we did do a brief assement, both patients denied any head, neck, or back pain or any other pain,. and both patients did not want to be in any kind of immoblization devices,... has they were both stable. the paramedic (my preceptor) did not find the need to do a thorough search for injuries, we actually transported one on the bench and one in the airway seat. The only medical treatment we provided was irrigating the wounds and some gauze. I had asked the paramedic after we turend over the patients to triage why we hadn't done a more thorugh search and he explained to me that it wasn't neccessary due to the fact that they had no pain and nothing abnormal in the rapid assesment we did do on them. And when we did turn them over to the nurse i was telling the nurse what we had and said 2 females, because at the time i didn't know about the whole its a guy thing. Although i do think back now and maybe i shoiuld have argued the point that this was a major car accident and I do know things can be very misleading, but i am fairly new to this and figured he knew best.

[paramedicmike]

I have a couple thoughts:

First, why is this in "Funny stuff"? Do you find it funny that there was a question as to the gender of one of the individuals you transported?

Second, and I'd like you to really think about this, was it really smart to transport two patients from a wreck as you described without any immobilization? Do you really think that someone who's been through a wreck like what you described is capable of making a competent decision regarding not wanting to be transported? Do you think, given the excitement and adrenaline rush of having been in the accident, that there was a chance that they were so hyped that they might not feel an injury right away?

Lastly, you need to find a new preceptor.

[island emt]

we did do a brief assement, both patients denied any head, neck, or back pain or any other pain,. and both patients did not want to be in any kind of immoblization devices,... has they were both stable. the paramedic (my preceptor) did not find the need to do a thorough search for injuries, we actually transported one on the bench and one in the airway seat. The only medical treatment we provided was irrigating the wounds and some gauze. I had asked the paramedic after we turend over the patients to triage why we hadn't done a more thorugh search and he explained to me that it wasn't neccessary due to the fact that they had no pain and nothing abnormal in the rapid assesment we did do on them. And when we did turn them over to the nurse i was telling the nurse what we had and said 2 females, because at the time i didn't know about the whole its a guy thing. Although i do think back now and maybe i shoiuld have argued the point that this was a major car accident and I do know things can be very misleading, but i am fairly new to this and figured he knew best.

While I'll agree that not everyone needs to be fully immobilized & we have a spinal protocol that allows us to make an informed decision process on whether to package or not, it was still a MVC rollover that required someone to be forcefully extricated from the wreckage. A crash that causes that much deformation of the vehicle will send the alarm bells ringing in my head. When in doubt package them as the ass you save might be your own.